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Study finds most Oregon
hospices do not fully participate in the
Death with Dignity Act
September 2010--A survey in the latest issue of the Hastings
Center Report found
that most hospices in Oregon, the first
state to legalize physician-assistance in
dying, either do not participate in or have
limited participation in requests for such
assistance. Both legal and moral reasons are
This finding is significant because hospices
are considered important for assuring that
physician-assisted death is carried out
responsibly, write the authors, Courtney S.
Campbell, the Hundere Professor of Religion
and Culture at Oregon State University, and
Jessica C. Cox, the Hundere Program
Assistant and a second year graduate student
at Oregon State.
Most patients in Oregon who choose
physician-assisted death are enrolled in
hospice care. Hospices' role is largely
confined to providing information about the
law in a neutral manner, the study found.
Patients must then work on their own to find
physicians who are willing to help them die.
The survey report was based on responses from
55 hospice programs in Oregon, or 86 percent
of the total. It compared their policy
statements, program guidelines, and staff
education materials to address patient
inquiries about the Death with Dignity Act.
The act, passed in 1995, permits physicians to
prescribe a fatal dose of medication to a
terminally ill patient who requests it, as
long as several criteria are met.
Twenty-five percent of the hospices surveyed
did not participate in the law at all and 27
percent had limited participation, meaning
that when patients asked about
physician-assisted death a staff member
merely referred them to the attending
physician without any conversation.
All of the hospices prohibited staff from
helping patients obtain and take medications
to end their lives. Few of the programs had
a policy allowing staff to be with patients
when they took life-ending medication.
The study identified legal and moral reasons
for these restrictions. Since Oregon's Death
with Dignity Act sanctions aid in dying from
a physician only, a compassionate hospice
staff member who offers assistance risks
violating laws against assisting suicide,
mercy killing, active euthanasia, or
homicide. Certain values also inhibit
hospices from participating more fully in
physician-assisted death. "Core values (such
as commitments not to abandon patients and
to neither hasten nor postpone death) are
necessarily in tension and do not lend
themselves to a clear consensual conclusion
for hospice providers," the authors write.
The authors conclude that hospices can avoid
the legal and moral obstacles by adopting a
position of "studied neutrality," which
recognizes a diversity of views among
providers and patients about
physician-assisted death and encourages open
discussion about the issue.
can bring much-needed dialogue and
transparency to a process that is
unnecessarily opaque, permit hospice
programs to acknowledge tensions in their
core values, and promote efforts to assure
congruence among values, policies, and
procedures," they write.